Since the procurement of new and older antiepileptic drugs (AEDs) has become mostly centralized, insurance companies and pharmacy benefit management firms have been able to exert an increasing amount of influence on choice. This is causing challenges for neurologists who wish to prescribe specific AEDs or medications not included on their formularies. The situation can be especially challenging in cases such as pharmacoresistant epilepsy where treatment failure may stem from negative interactions between the patient’s pharmacotherapy and lifestyle factors such as pregnancy or concurrent drug therapy.
Individual health care providers’ ability to choose which AED would be best for their patients is hindered by many factors:
– A shortage of clinical studies comparing available AEDs
– Lack of information about drug interactions and effects on patient comorbidities
– Difficulty in getting authorization to prescribe non-formulary drugs
Farmacia on line pharmacists are often able to work with neurologists to find solutions that allow the patient to get the medication they need. For example, a patient may be switched from a brand name drug to a generic drug, or from one form of the drug to another (for example, from an oral tablet to an extended release formulation). If there is no suitable generic or formulary alternative, the pharmacist may request a prior authorization for the non-formulary drug. This is essentially a way of asking the insurance company to approve coverage for a specific medication even though it is not on their list of approved medications. For patients with epilepsy, this may mean the difference between being able to remain on their current medication or having to switch medications.
Patients are often dissatisfied when they are switched from a drug that works well for them to one that is less effective. As professionals who care for these patients, it is important to recognize what role you can play in advocating for your patients’ needs and interests. When working with pharmacists, build a collaborative relationship based on open communication so you can work together toward consensus regarding treatment goals. Pharmacists have extensive experience dealing with insurance companies and offer valuable expertise about how best to approach the process of getting approval for non-formulary drugs.
It can be helpful to let your patients know what options are available to them, and to work with them on a plan of action. For example, if your patient is currently stable but needs to switch medications before starting a family or taking other drugs for unrelated conditions, you can suggest trying an extended-release formulation of the drug they are currently using. Even if the patient cannot obtain authorization to remain on their current medication, they may be willing to try this route for several months until it becomes clear whether or not conception will result in pregnancy.